If misery loves company, PMS sufferers are an empathetic crowd. But by taking a proactive approach to this recurring condition---starting with diet and exercise--you may be able to eliminate the physical and emotional toll it's taking.
If you're one of the 80 percent of the female population who have premenstrual syndrome (PMS), you know it's hardly the joke that TV comedians make it out to be. Every month you really do feel crabby, crave that whole box of chocolates and suffer from breast tenderness, bloating, cramps, weight gain or headaches--and sometimes all at once. The discomfort may last from just a few hours to several days. Or it may begin a week or two before your peroid and stop abruptly when the bleeding starts. Because PMS can elicit some 150 different symptoms, there's really no typical case. And while most women find it annoying rather than disabling, an estimated 3 to 8 percent have truly severe symptoms, suffering from a variety of physical problems as well as serious depression--a condition called premenstrual dysphoric disorder or PMDD.
Research remains inconclusive about the cause of PMS. Many exerts blame an imbalance of the female hormones oestrogen and progesterone, which may interfere with the brain chemicals that control mood and pain. Other suspect low levels of serotonin, a brain chemical associated with emotional wellbeing. Additional culprits may include nutritional deficiencies, fluid and sodium retention, low blood sugar and a heightened stress response. Although no one theory can offer a satisfactory explanation for all women, what is known is that there's a natural limit to PMS: symptoms, which usually strike in the mid-20's, generally subside after age 35, and disappear completely with menopause.
LIKELY FIRST STEP
Many women simply accept PMS as an unfortunate fact of life: a 1999 survey found that those who suffered the most were the least likely to seek treatment, believing nothing could be done. Yet PMS is very treatable. If your symptoms are on the mild side, adopting a healthier lifestyle may be all it takes to make you feel better. For moderate or severe PMS or PMDD, you're likely to require some pharmaceutical help. Once you find the right therapy, however, you should be virtually free of symptoms after three menstrual of cycles.
Lifestyle changes
One easy way to begin controlling your PMS symptoms is to adopt a low-fat, high-fibre eating program that's light on junk food and heavy on fresh produce, whole grains and legumes. Whole foods tend to be high in complex carbohydrates, help with irritability because they raise blood levels of tryptophan, an amino acid that converts to the mood-elevating hormone serotonin. Munching on fresh fruit and whole-grain breads may also curb an unhealthy appetite for sugary treats or salty snacks--foods you might crave but than often lead to water retention or a bad mood. You'll also need to beware of caffeine. While coffee, tea and colas can increase urination, they can also increase your irrability and sleep problems.
In addition to diet, regular exercise also helps reduce many PMS symptoms. At the very last, aim for 30 minutes of aerobic exercise--walking, swimming, cycling --three times a week. In addition, try some stress-reduction techniques--yoga, guided imagery, meditation--to help you relax and better cope with any emotional symptoms. And don't forget the ultimate in relaxation: sleep. Some women with PMS seem to sleep too much; others, too little. (see Insomnia on previous, for ways to regulate your sleep habits.)
Treatment Options
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Eating plan & exercise Good diet, regular aerobics key for relief.
----------------------------------------------------------------------------------------------------------------------------------------------
Stress reduction Yoga, meditation, visualisations, for tension.
---------------------------------------------------------------------------------------------------------------------------------------------
Improved sleep habits Can prevent PMS-related insomnia.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Vitamins & minerals To start, calcium, magnesium, vitamin B6.
-----------------------------------------------------------------------------------------------------------------------------------------------
Progesterone cream May be helpful.
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Pain relievers Analgesics; bromocriptine for breast pain.
------------------------------------------------------------------------------------------------------------------------------------------ Diuretics Try Aldactone for bloating.
-------------------------------------------------------------------------------------------------------------------------------------------
Oral contraceptives To keep hormonal fluctation in check.
------------------------------------------------------------------------------------------------------------------------------------------- Antidepressants Prozac, other SSRIs, for serious depression.
TAKING CONTROL
In addition to making some lifestyle changes, many women with PMS have had success using the following natural products, as well as the herbal remedies mentioned in the box opposite:
Calcium. In a study from Columbia University, PMS patients who took 1200 mg of supplemental calcium daily for three months reported a 48 percent reduction in such PMS symptoms as breast tenderness, bloating, headaches and moodiness.
Magnesium. During the last two weeks of your menstrual cycle, magnesium levels naturally fall, which may increase water retention, headaches and irrability, some researchers say. Try taking 250 mg of this mineral twice a day, everyday, with food.
HERBAL REMEDIES FOR PMS
If you want to use herbs for PMS symptoms, allow three months for noticeable benefits. Be sure to tell your doctor.
Natural progresterone cream. This is synthesised progesterone, which may be of help. Look for a 2 percent progesterone cream, such as Pro-Gest, that has at least 400 mg of progesterone per 30 grams. Apply about 1/2 teaspoon twice a day, following label directions, during the two weeks before your period.
PROMISING DEVELOPMENTS
For mild PMS aches and pains, pain relievers such as aspirin, ibuprofen (Nurofen) or naproxen (Naprogesic) often work well. You can also try a specialised product such as Midol, Pamprin or Premysn, which contains acetaminophen along with a diuretic and/or an antihistamine. For severe breast pain, ask your doctor about a prescription dopamine agonist called bromocriptine (Parlodel). It reduces the levels of the hormone prolactin, which controls lactational changes in your body, but it can sometimes cause side effects.
If you have bloating that doesn't respond to dietary measures, a prescription diuretic may help eliminate water and sodium. One of the best is spironolactone (Aldactone); unlike other diuretics, it doesn't deplete potassium, which can lead to heart rhythm disturbances. Or if hormonal fluctuations are your problem, you may be given an oral contraceptive that contains both progestins (either natural or synthetic forms of progesterone) and oestrogen. A new combination contraceptive called Yasmin contains both oestrogen and drospirenone, a substance similar to natural progesterone. It regulates mood swings and may relieve the emotional distress of PMDD.
Also useful are antidepressants called selective serotonin reup-take inhibitors (SSRIs), such as sertraline (Zoloft) and paroxetine (Aropax), which increase mood-elevating serotonin. Recently, fluoxetine (Prozac) became the first SSRI approved for treating PMDD as well as PMS. Prozac is taken right before your period and can be taken 10 to 14 days each cycle or continuously.
What is happening
If you're one of the 80 percent of the female population who have premenstrual syndrome (PMS), you know it's hardly the joke that TV comedians make it out to be. Every month you really do feel crabby, crave that whole box of chocolates and suffer from breast tenderness, bloating, cramps, weight gain or headaches--and sometimes all at once. The discomfort may last from just a few hours to several days. Or it may begin a week or two before your peroid and stop abruptly when the bleeding starts. Because PMS can elicit some 150 different symptoms, there's really no typical case. And while most women find it annoying rather than disabling, an estimated 3 to 8 percent have truly severe symptoms, suffering from a variety of physical problems as well as serious depression--a condition called premenstrual dysphoric disorder or PMDD.
Research remains inconclusive about the cause of PMS. Many exerts blame an imbalance of the female hormones oestrogen and progesterone, which may interfere with the brain chemicals that control mood and pain. Other suspect low levels of serotonin, a brain chemical associated with emotional wellbeing. Additional culprits may include nutritional deficiencies, fluid and sodium retention, low blood sugar and a heightened stress response. Although no one theory can offer a satisfactory explanation for all women, what is known is that there's a natural limit to PMS: symptoms, which usually strike in the mid-20's, generally subside after age 35, and disappear completely with menopause.
- A healthy diet to reduce bloating and curb carvings.
- Stress reduction through regular exercise and mind-soothing techniques.
- Vitamins and other nutritional supplements to balance body chemistry.
- Analgesics to ease aches and to relieve bloating
- Antidepressants for PMDD or if PMS-related depression fails to lift with lifestyle measures.
QUESTIONS TO ASK
- If I'm depressed only some of the time, why do I need an antidepressant?
- Could I be suffering from seasonal affective disorder?
- Will PMS or any treatment for it make it harder for me to conceive?
- Do you think a special PMS clinic or support group might help me?
Treatments
Many women simply accept PMS as an unfortunate fact of life: a 1999 survey found that those who suffered the most were the least likely to seek treatment, believing nothing could be done. Yet PMS is very treatable. If your symptoms are on the mild side, adopting a healthier lifestyle may be all it takes to make you feel better. For moderate or severe PMS or PMDD, you're likely to require some pharmaceutical help. Once you find the right therapy, however, you should be virtually free of symptoms after three menstrual of cycles.
Lifestyle changes
One easy way to begin controlling your PMS symptoms is to adopt a low-fat, high-fibre eating program that's light on junk food and heavy on fresh produce, whole grains and legumes. Whole foods tend to be high in complex carbohydrates, help with irritability because they raise blood levels of tryptophan, an amino acid that converts to the mood-elevating hormone serotonin. Munching on fresh fruit and whole-grain breads may also curb an unhealthy appetite for sugary treats or salty snacks--foods you might crave but than often lead to water retention or a bad mood. You'll also need to beware of caffeine. While coffee, tea and colas can increase urination, they can also increase your irrability and sleep problems.
In addition to diet, regular exercise also helps reduce many PMS symptoms. At the very last, aim for 30 minutes of aerobic exercise--walking, swimming, cycling --three times a week. In addition, try some stress-reduction techniques--yoga, guided imagery, meditation--to help you relax and better cope with any emotional symptoms. And don't forget the ultimate in relaxation: sleep. Some women with PMS seem to sleep too much; others, too little. (see Insomnia on previous, for ways to regulate your sleep habits.)
Treatment Options
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Eating plan & exercise Good diet, regular aerobics key for relief.
----------------------------------------------------------------------------------------------------------------------------------------------
Stress reduction Yoga, meditation, visualisations, for tension.
---------------------------------------------------------------------------------------------------------------------------------------------
Improved sleep habits Can prevent PMS-related insomnia.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Vitamins & minerals To start, calcium, magnesium, vitamin B6.
-----------------------------------------------------------------------------------------------------------------------------------------------
Progesterone cream May be helpful.
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Pain relievers Analgesics; bromocriptine for breast pain.
------------------------------------------------------------------------------------------------------------------------------------------ Diuretics Try Aldactone for bloating.
-------------------------------------------------------------------------------------------------------------------------------------------
Oral contraceptives To keep hormonal fluctation in check.
------------------------------------------------------------------------------------------------------------------------------------------- Antidepressants Prozac, other SSRIs, for serious depression.
TAKING CONTROL
- Keep a symptoms diary for at least a few months, charting how you feel and when, as well as dates when your period starts and ends. This will show the cycle of your symptoms and help your doctor eliminate other possibilities. Often problems are due to another ailment, such as pain linked to menstruation (dysmenorrhea) or seasonal affective disorder (SAD).
- Don't eat meat. A 2000 study found that women who ate a low-fat vegetarian diet for two menstrual cycles had less pain and bloating than meat eaters. Try replacing red meat with salmon, tuna or other oily fish, which are rich in the omega-3 fatty acids that can help relieve menstrual cramps and possibly related depression.
- Try cognitive-behavioural therapy. If you suffer from depression or feelings of hopelessness due to PMS or PMDD, a psychologist can help you master techniques for solving problems, managing obstacles and restructuring priorities. The therapist will give you new ways of thinking about your condition so you can overcome pessimistic thoughts and regain a sense of control.
In addition to making some lifestyle changes, many women with PMS have had success using the following natural products, as well as the herbal remedies mentioned in the box opposite:
Calcium. In a study from Columbia University, PMS patients who took 1200 mg of supplemental calcium daily for three months reported a 48 percent reduction in such PMS symptoms as breast tenderness, bloating, headaches and moodiness.
Magnesium. During the last two weeks of your menstrual cycle, magnesium levels naturally fall, which may increase water retention, headaches and irrability, some researchers say. Try taking 250 mg of this mineral twice a day, everyday, with food.
HERBAL REMEDIES FOR PMS
If you want to use herbs for PMS symptoms, allow three months for noticeable benefits. Be sure to tell your doctor.
- Chasteberry (vitex) helps normalise the ratio of the femal hormones progesterone and oestrogen, thus providing relief for irritability, depression and bloating. Avoid it with oral contraceptives, HRT or bromocriptine.
- Evening primrose oil contains an essential fatty acid (EFA) called gamma-linolenic acid (GLA), which reduces
- cramping by interfering with the production of inflammatory hormone-like chemicals called prostaglandins. It may also relieve bloating, breast tenderness and irritatbility.
- St John's wort is used for mild to moderate depression. It appears to boost levels of the brain chemical serotonin, which controls moods and emotions. Avoid using this herb if you're on antidepressants or oral contraceptives.
- PMS herbal combinations provide a number of helpful herbs in one convenient tablet or capsule. Some also contain the vitmains C, E and B plus magnesium.
Natural progresterone cream. This is synthesised progesterone, which may be of help. Look for a 2 percent progesterone cream, such as Pro-Gest, that has at least 400 mg of progesterone per 30 grams. Apply about 1/2 teaspoon twice a day, following label directions, during the two weeks before your period.
- One day soon you might literally be able to sniff your PMS symptoms away. A new nasal spray called PH80 is now in clinical trials overseas. The spray stimualtes nerve receptors just inside your nasal passages, which then send impulses to the hypothalamus, the area of your brain that regulates reproduction, stress and emotions. Earlier research indicated PH80 had a positive effect on reducing anxiety, and scientists are optimistic that it may one day provide a safer, easier-to-use alternative to SSRIs for treating PMS/PMDD mood swings and depression.
For mild PMS aches and pains, pain relievers such as aspirin, ibuprofen (Nurofen) or naproxen (Naprogesic) often work well. You can also try a specialised product such as Midol, Pamprin or Premysn, which contains acetaminophen along with a diuretic and/or an antihistamine. For severe breast pain, ask your doctor about a prescription dopamine agonist called bromocriptine (Parlodel). It reduces the levels of the hormone prolactin, which controls lactational changes in your body, but it can sometimes cause side effects.
If you have bloating that doesn't respond to dietary measures, a prescription diuretic may help eliminate water and sodium. One of the best is spironolactone (Aldactone); unlike other diuretics, it doesn't deplete potassium, which can lead to heart rhythm disturbances. Or if hormonal fluctuations are your problem, you may be given an oral contraceptive that contains both progestins (either natural or synthetic forms of progesterone) and oestrogen. A new combination contraceptive called Yasmin contains both oestrogen and drospirenone, a substance similar to natural progesterone. It regulates mood swings and may relieve the emotional distress of PMDD.
Also useful are antidepressants called selective serotonin reup-take inhibitors (SSRIs), such as sertraline (Zoloft) and paroxetine (Aropax), which increase mood-elevating serotonin. Recently, fluoxetine (Prozac) became the first SSRI approved for treating PMDD as well as PMS. Prozac is taken right before your period and can be taken 10 to 14 days each cycle or continuously.
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